Contractor-priced
0735T · PFS Q4 2023 · Historical
No national PFS rate in Q4 2023
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Check for a published amount in your locality.
PFS status evidence
Inspect PFS status evidence
- Code
- 0735T
- Release
- Q4 2023, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU23DOctober 1 – December 31, 2023
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU23_OCT.csv row 6,329 in rvu23d.zip
In the CMS file
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6558dc4fa634f462f996db05a7e6af5cbe365e93e508b8e24d1cbfb1f610dcbd
CPT 0735T has no published national rate. It carries status C (carrier-priced) in the Q4 2023 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank amount means unpriced, not $0.
Why is there no national PFS amount for 0735T?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to 0735T: GLOB DAYS ZZZ (add-on code) · ASST SURG 2 (payable) · CO SURG 1 (payable with documentation).
Add-on code
GLOB DAYS
ZZZ
This code is always billed alongside another service and carries no follow-up period of its own. The primary procedure's global period governs; this indicator does not determine whether either line is payable.
Payable
ASST SURG
2
An assistant at surgery may be separately paid for this procedure, typically as a percentage of the fee schedule amount.
Payable with documentation
CO SURG
1
Co-surgeons may be paid, but only with supporting documentation establishing the medical necessity of two surgeons.
Why would a Medicare claim for 0735T be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is C (carrier-priced)—Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. See status indicators
- Bilateral surgery: no bilateral adjustment. See billing policy
- Co-surgeons: payable with documentation. See billing policy
- Team surgery: not permitted. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
CMS RVU23DOctober 1 – December 31, 2023
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 0735T Copy link
What to check (5)
There is no national allowed amount for 0735T, so every reconciliation of this line runs against the MAC fee schedule that was in force for the date of service rather than against a national baseline.
- Compare the paid amount against the MAC fee schedule in force for the date of service; there is no national allowed amount here to reconcile against.
- Reconcile this line together with the primary procedure on the same claim—it is an add-on that is never billed alone and carries no global period of its own.
- Check that any -80 or -AS line was priced from the same release and locality as the primary line; an assistant at surgery prices at a percentage of the fee-schedule amount.
- Check for documentation supporting two surgeons before appealing a modifier 62 denial—co-surgeon payment on this procedure depends on it.
- Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Medicare Claims Processing Manual (Pub. 100-04); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
Source & method Copy link
The PFS file shows this code is priced by the contractor. Its amounts come from the MAC-published schedules and effective dates shown above.
-
01 PPRRVU23_OCT.csv · Q4 2023 (RVU23D) · row 6,329—priced by the contractor
- Effective
- October 1 – December 31, 2023
- Locator
- PPRRVU23_OCT.csv in rvu23d.zip · row 6,329 of 18,168 · via CMS
- Fields read
-
Status C (col 4)SHA-256 6558dc4fa634f462…
Cite this rate
CPT 0735T National PFS baseline: No national PFS rate (Q4 2023; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU23D, PPRRVU23_OCT.csv row 6,329. Localis. https://localishealth.com/cpt/0735T/2023/D
Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON
How has it changed? Copy link
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
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